Excluded Older People: New Policy Approaches David Bartram Social Exclusion Unit W. and SW. Regional

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Excluded Older People New Policy
ApproachesDavid BartramSocial Exclusion Unit
W. and SW. Regional Housing LIN
Weston-Super-Mare 21st July 2005
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We have used a wide definition of social
exclusion to include not just those living in
poverty, but people excluded by reason of chronic
ill health, caring responsibilities etc.An
experience characterised by poverty and the lack
of access to social networks, activities and
services that results in a poor quality of life
What is social exclusion?
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Eleanor Rigby was isolated and excluded-
Waits at the window, wearing the face that she
keeps in a jar by the door, who is it for?
wearing make-up even though no-one visits. -
She died in the church and was buried along with
her name, nobody came. No friends, relatives or
carers attended the funeral. No-one will
remember her.
The policy shortcut Celebrity as a driver of
change
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Do overall resources reflect the scale of the
problem?many older people experience exclusion
affecting their everyday lives...

• There is significant public spending on older
  people, but not just health, social care and
  pensions. However there is significant unmet
  need and inequity with other age groups in some
  areas.

• 2.1 million people of pension age live in
  poverty. 50 is due to benefits take-up
• Around 30 of people over 65 do not see any
  friends at least once a week
• 1 in 6 people aged 65 and over are affected by
  depression.
• 60 of people aged 65 and over have a
  long-standing illness.
• Approximately one-third of people living in
  non-decent homes are 60 or over.
• Every year there are more than 20,000 excess
  winter deaths amongst older people.

Limiting illness
MULTIPLE EXCLUSION
Poverty
Poor housing
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Where do excluded older people live? excluded
older people do not just live in areas of
deprivation ...
There are higher proportions of people above
state pension age in some areas, including rural
and coastal areas where isolation and exclusion
from services is a key issue.
Patterns of Poverty

• There are high concentrations of older
  people on low incomes in some areas including the
  North East, North West, West Midlands and Greater
  London

Source Office for National Statistics and NRU
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(No Transcript)
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Housing Issues and Older People
The majority of older people are owner occupiers,
although this proportion decreases with age. In
2001 80 of older people aged 50-64 living in
private households in Great Britain were
owner-occupiers. This compares to 72 of people
aged 65 to 84 and 61 of people aged 85 and over
Overall 15 of older people live in poor housing
(housing that is unfit, in serious disrepair or
in need of essential modernisation) And over 50
over non-decent homes are lived in by older
people. (Pie chart shows those living in
non-decent home by age of oldest member)
By 2011, estimates suggest there will be around
6m owner occupiers who are 60, compared with
4.5m in 1997/98.
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Are we planning ahead to predict future patterns?
the population is getting older and this will
affect exclusion and public spending. A positive
response is needed...

• Economic challenges and new opportunities
• Public spending will be affected by an ageing
  population. For
  example the JRF calculated social care costs
  could double in 25 years.
• Many excluded older people require intensive
  services and support.
• An ageing population with high levels of
  exclusion will have considerable economic and
  social consequences.
• BUT exclusion, loss of function and acute needs
  are not an inevitable consequence of ageing.
• Preventative services and a positive approach to
  ageing would result in improved quality of life
  and reduced demand for expensive services.

This map shows the change in numbers over state
pension age by area (1991 - 2001). Some parts of
the country will have greater costs than others.
Over 50s make up 33 of the population and the
number is projected to increase by 37 by 2031
bringing the number of people aged 50 close to
27m.
Source Office for National Statistics
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What research is needed?funding streams and
provision of services can changed to better fit
these patterns...

Further exploitation of existing data is needed
to understand basic geographical and demographic
patterns of current and future need and ensure
funding formula reflect this. Service providers,
local and central government need to know how to
find the most excluded. Map of loneliness!
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Some Consultation Responses
Quality of life is about having choices.
Services for older people are still often
designed to suit the provider and lack
flexibility.
Its OK to know you can do this, do that, and do
the other thing but if you cant get out and
about youre trapped, youre just unable to
socialise.
When I came here first ( to this group ), I was
absolutely terrified. I didnt really want to
come that morningshe was so kind ( the organiser
)I thought I cant do this, but I did and Ive
never looked back.
you want to feel that you are of some use to
society that youre not just shoved on the
scrapheap and that nobody you know, that nobody
cares about you or the things that youve done in
your life, the experiences that could be useful
to other people
Social networks suffer as people get older and
it becomes harder to make new friends. Social
isolation leads to depression, loneliness,
anxiety which in turn stop people from
interacting with their local community and
accessing the services they need.
The decline of community life and the break up
of the traditional family model, can leave older
people with few, if any, opportunities for social
interaction
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Consultation said exclusion is a result of
Bureaucracy
Poor health
Lack of access to leisure
Social isolation
Together these result in multiple disadvantage
Fear of crime
Poverty
Lack of appropriate transport
Inappropriate services
Age Discrimination
Lack of information
Services not joined-up
Services not responsive to needs of users
Lack of lower level services
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Three priorities for improving services
The views expressed by respondents distil down
to three key themes for how services for excluded
older people should be delivered in the future.
Keele research also supports this approach to
deliver coordinated solutions that address but
also go beyond poverty and preventative policies
to support people at key turning points in their
lives.
1 - Early intervention and low level services
2 - Promoting user involvement, choice and
control
3 - Joined up and co-ordinated services
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1 - Early intervention and low-level services
Early intervention and low level services

• The current provision of services for excluded
  older people is focused on providing intensive,
  costly services once problems arise.
• Shifting the emphasis to providing lower level
  services, earlier - before people develop
  intensive needs - means there will be less need
  for intensive services in the future. This is
  better for individuals and less costly.

Relatively small numbers of people with high
levels of need receiving care. Larger numbers
of people who fall outside eligibility criteria
for services but may benefit from lower level
services.
Improved access to universal
services. Better joined up rehabilitation servi
ces. Lower levels of high cost intensive care
services.
Adapted from ADSS/LGA All our tomorrows
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Early intervention and low level services
The right bit of help, for the right person
...the same services will affect people
differently...
Physical and Practical
Personal and Social
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...at the right time early intervention is
critical...services are most effective if
delivered at key points where risk of decline is
high...
Early intervention and low level services

• What does the Keele research identify as key risk
  points in a persons life?
• Major risk points include the death of a carer or
  relative dies, loss of employment, being a victim
  of crime and ill health. Vulnerability is
  increased when living alone and when social
  contact declines

ChildhoodGrowth and development
Younger Adult LifeMaintaining highest possible
level of function
Older Adult LifeMaintaining independence and
preventing disability
Preventative, low-level services and a positive
approach to ageing would maintain function across
the life-course.
Range of function in individuals
Functional Capacity
Enabling environments such a accessible
transport, home adaptations) can reduce the
disability threshold (Kalache and Kickbush, 1997)
Disability threshold
Age
Low level services can have a strong preventative
effect if the timing is right. At these times
services must join-up to meet multiple needs.
Decline in heath, falls etc
Change of role (loss of job, family move away)
Death of a carer or relative
Drop in income
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Promoting user involvement, choice and control

2 - Control and choice

• Excluded older people are diverse. Tailored
  services are needed to reflect different peoples
  circumstances, preferences and cultural
  backgrounds.
• Involving excluded older people in decisions and
  providing choice can empower people who may feel
  powerless. If people can take greater ownership
  of services the services become less stigmatised
  and more attractive.
• User involvement and choice can also lead to
  more efficient services, because individuals have
  a good understanding of what will work for them.
  Giving people more control - for example through
  direct payments - has also often reduced costs,
  because far from trying to milk the system,
  most people take only what they need.
• Quality of life is about having choices
  Consultation respondent.

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Promoting user involvement, choice and control

Empowering older people and tackling
discrimination

• Empowerment of older people and promotion of
  interdependence models.

you want to feel that you are of some use to
societythat youre not just shoved on the
scrapheap that nobody cares about you or the
things that youve done in your life, the
experiences that could be useful to other people

• Tackling discrimination is necessary to promote
  empowerment and interdependence.
• Changing the culture of society and people who
  provide goods and services to older people.
  Workforce reform and training should be
  considered.

One thing I could still say about discrimination
against older people is in clothing. Clothing
its all midriff, all these blouses just reach
below our bosoms and its all hipsters, trousers.

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A Positive Approach to Ageing

• Exclusion, loss of function and
  acute needs are not an inevitable
• consequence of ageing.
• More positive images of older
  people challenge age
• discrimination.
• With the right early intervention in
  later life older people can
• continue to learn and develop, and
  to contribute,
  
  
  
• Enabling environments, such as
  accessible transport and
• home adaptations to make it easier for older
  people to live
• independent lives people with
  needs are not the problem !!
• Not just a focus on public
  services.

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3 - Joining up ...older peoples services are
currently too disjointed with multiple access
points ...
Joined up and co-ordinated services
Joined up services are desirable for people of
all ages and from all backgrounds. Joined up
services are even more important for excluded
older people, who may have limited additional
contact with mainstream service providers and
lack the confidence and social capital to seek
out the services that they need. This means that
outreach, and proactive services, as well as
joining-up are important for excluded older
people.
Supporting People - providing an alarm and advice
Local Age Concern - befriending, lunch club
and home visiting
Disabled Facilities Grant - ramp and walk-in
shower
Warm Front - central heating
Primary Care Trust - community nurse
Housing Department - kitchen repair
Social Services - home carer and shopping
Example of different agencies and funding sources
supporting a person to remain in their own home
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Principles of service delivery people commented
that Sure Start model, for services for young
children, could work equally well for older
people..
Joined up and co-ordinated services
1. Working with older people Every older person
should get access to a range of services that
will deliver better outcomes, meeting their needs
and stretching their aspirations. 2. Services for
everyone But not the same service for everyone.
Older people have distinctly different needs.
Needs are different in different areas and a
persons needs also change over time. Services
should recognise and respond to these varying
needs. 3. Flexible at point of delivery All
services should be designed to encourage access.
For example, opening hours, location, transport,
mobility and caring issues need to be considered.
Where possible we must enable older people to get
the health, advice and support services they need
through a single point of contact. 4. Promoting
independence and well-being Services for older
people should be preventative in approach,
accessible earlier to promote independence and
well-being and halt decline. This means not only
health, housing and social care services but also
advice and support with transport, mobility,
leisure and employment. 5. Respectful and
transparent Services should be customer driven,
whether or not the service is free. 6. Community
driven and professionally co-ordinated All
professionals with an interest in older people
should be sharing expertise and listening to
local people on service priorities. This should
be done through consultation and by day to day
listening to older people. 7. Outcome driven All
services for older people need to have as their
core purpose better outcomes for older people. We
need to reduce bureaucracy and simplifying
funding to ensure a joined up approach with
partners.
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What future services might look like for an
excluded older person?
Joined up and co-ordinated services

• A SURE START model would enable a person
  entering at any place in the system to receive a
  seamless service.
• Key features
• As access to services is critical for excluded
  older people - this could be via an outreach
  service, or via the voluntary sector.
• The services available would not be limited to
  core statutory services. The voluntary and
  community sector would be fully involved and low
  level would be part of the provision.
• There would be local involvement in the
  direction of the service.

Finance benefits
Advocacy specialist advice
Safety environment
Housing
Transport
Excluded older person
Social care
Social activities
Health
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Government policy makers do not exist in a
vacuum sifting through evidence. Ask yourself
who cares and why? Are all the pieces in place?
- Wide academic and intellectual outrage?-
Broad voluntary sector outrage?- Older people
demanding much more?- Public informed e.g. press
representation?- High profile cases lonely
deaths, elder abuse? Often necessary before-
Senior political leadership and championing -
Legislative change- Additional commitment of
resources- Machinery of government changes
How will social change occur for excluded older
people?
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Where might we offer new leadership?
Gives a clearer voice to excluded older people
who experience poverty and the lack of access to
social networks, activities and services that
results in a poor quality of life. Renewed
tackling of poverty and better services important
but not enough to end exclusion. We need a new
policy push on isolation and poverty of social
relations. www.socialexclusion.gov.uk
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Interim report published on 15th March 2005
contains initial findings we see that as a
second stage of consultation. Further in depth
consultation particularly with excluded older
people themselves. Develop work on the themes
referred to earlier. Develop an agreed set of
actions across Government for Excluded Older
People. Final report out by January. www.socialexc
lusion.gov.uk
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• Some possible questions
• What are your top three policy priorities?
• Are our themes broadly right? What should
  central government, local government and
  individual providers do?
• When are low level services most effective? What
  low level services are most effective and what
  evidence is there?
• How can user involvement in services be made more
  effective?
• What services should be joined up at a
  neighbourhood level?
• Should tackling poverty be prioritised over other
  areas?
• How can social networks be best encouraged to
  develop?
• How can research be exploited to meet governments
  needs?
• What would a map of loneliness look like!?